MAJOR CARDIAC FINDINGS AT NECROPSY IN 366 AMERICAN OCTOGENARIANS

We examined the hearts of 366 octogenarians (184 women [50%], 264 white [72%], mean age 84 +/- 4 years). The cause of death was cardiac in 195 (53%), noncardiac but vascular in 47 (13%), and noncardiac and nonvascular in 124 patients (34%). Of the 195 patients with fatal cardiac disease atherosclerotic coronary artery disease was the cause of death in 127 (65%): acute myocardial infarction in 87 (69%), sudden cardiac arrest outside the hospital in 19 (15%), chronic congestive heart failure with healed myocardial infarction in 15 (12%), and complications of coronary bypass surgery in 6 (4%). At least 1 of the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries was narrowed > 75% in cross-sectional area by atherosclerotic plaque in 218 patients (60%). The mean number of significantly narrowed major epicardial coronary arteries was 1.7, 1.3, and 0.7 in those who died of cardiac, peripheral vascular, or noncardiovascular causes, respectively. Among the 87 patients (33 men and 54 women) with fatal acute myocardial infarction, the women more often had ruptured ventricles (21 of 54 [39%] vs 3 of 33 [9%]), and fewer women had healed myocardial infarcts (11 of 54 [20%] vs 24 of 33 [73%], p < 0.05). Calcific deposits were present in the epicardial coronary arteries in 285 patients (78%), in the mitral annulus in 140 (38%), and in aortic valve cusps in 153 (42%). Most octogenarian women with fatal acute myocardial infarction had no previous nonfatal infarcts, but had a high frequency of cardiac rupture; in contrast, most men with a fatal acute myocardial infarction had had a nonfatal infarct and a low frequency of cardiac rupture. Sudden death was uncommon in both sexes in this age group.